Hanna Augustsson

Investigating variations in implementation fidelity of an organizational-level occupational health intervention.

BackgroundThe workplace has been suggested as an important arena for health promotion, but little is known about how the organizational setting influences the implementation of interventions.PurposeThe aims of this study are to evaluate implementation fidelity in an organizational-level occupational health intervention and to investigate possible explanations for variations in fidelity between intervention units.MethodThe intervention consisted of an integration of health promotion, occupational health and safety, and a system for continuous improvements (Kaizen) and was conducted in a quasi-experimental design at a Swedish hospital. Implementation fidelity was evaluated with the Conceptual Framework for Implementation Fidelity and implementation factors used to investigate variations in fidelity with the Framework for Evaluating Organizational-level Interventions. A multi-method approach including interviews, Kaizen notes, and questionnaires was applied.ResultsImplementation fidelity differed between units even though the intervention was introduced and supported in the same way. Important differences in all elements proposed in the model for evaluating organizational-level interventions, i.e., context, intervention, and mental models, were found to explain the differences in fidelity.ConclusionImplementation strategies may need to be adapted depending on the local context. Implementation fidelity, as well as pre-intervention implementation elements, is likely to affect the implementation success and needs to be assessed in intervention research. The high variation in fidelity across the units indicates the need for adjustments to the type of designs used to assess the effects of interventions. Thus, rather than using designs that aim to control variation, it may be necessary to use those that aim at exploring and explaining variation, such as adapted study designs.

Promoting employee health by integrating health protection, health promotion, and continuous improvement: a longitudinal quasi-experimental intervention study.

Objective:To test the effects of integrating health protection and health promotion with a continuous improvement system (Kaizen) on proximal employee outcomes (health promotion, integration, and Kaizen) and distal outcomes (workability, productivity, self-rated health and self-rated sickness absence). Methods:Twelve units in a county hospital in Sweden were randomized to control or intervention groups using a quasiexperimental study design. All staff (approximately 500) provided self-ratings in questionnaires at baseline, and a 12- and 24-month follow-up (response rate, 79% to 87.5%). Result:There was a significant increase in the proximal outcomes over time in the intervention group compared with the control group, and a trend toward improvement in the distal outcomes workability and productivity. Conclusions:Integration seems to promote staff engagement in health protection and promotion, as well as to improve their understanding of the link between work and health.

The Need for Dual Openness to Change: A Longitudinal Study Evaluating the Impact of Employees’ Openness to Organizational Change Content and Process on Intervention Outcomes:

This study investigates how individual- and group-level openness to organizational change, concerning change content and process, affects intervention outcomes. The intervention aimed to improve primary health care employees’ competence in and use of information and communication technologies (ICT). Employees’ (n = 1,042) ratings of their openness to the change content and process as well as of their workgroup’s openness to the change content before the intervention were used to predict ICT competence and its use 18 months later. Openness to the change process predicted both ICT competence and use of competence, while openness to the change content and group openness predicted use of competence only. These results show that individual- and group-level openness to organizational change are important predictors of successful outcomes. Furthermore, employees should be open both to the content of the change and to the process by which the intervention is implemented in order to maximize outcomes.

Empirical and conceptual investigation of de-implementation of low-value care from professional and health care system perspectives: a study protocol

BackgroundA considerable proportion of interventions provided to patients lacks evidence of their effectiveness. This implies that patients may receive ineffective, unnecessary, or even harmful care. Thus, in addition to implementing evidence-based practices, there is also a need to abandon interventions that are not based on best evidence, i.e., low-value care. However, research on de-implementation is limited, and there is a lack of knowledge about how effective de-implementation processes should be carried out. The aim of this project is to explore the phenomenon of the de-implementation of low-value health care practices from the perspective of professionals and the health care system.MethodsTheories of habits and developmental learning in combination with theories of organizational alignment will be used. The project’s work will be conducted in five steps. Step 1 is a scoping review of the literature, and Step 2 has an explorative design involving interviews with health care stakeholders. Step 3 has a prospective design in which workplaces and professionals are shadowed during an ongoing de-implementation. In Step 4, a conceptual framework for de-implementation will be developed based on the previous steps. In Step 5, strategies for de-implementation are identified using a co-design approach.DiscussionThis project contributes new knowledge to implementation science consisting of empirical data, a conceptual framework, and strategy suggestions on de-implementation of low-value care. The professionals’ perspectives will be highlighted, including insights into how they make decisions, handle de-implementation in daily practice, and what consequences it has on their work. Furthermore, the health care system perspective will be considered and new knowledge on how de-implementation can be understood across health care system levels will be obtained. The theories of habits and developmental learning can also offer insights into how context triggers and reinforces certain behaviors and how factors at the individual and the organizational levels interact. The project employs a solution-oriented perspective by developing a framework for de-implementation of low-value practices and suggesting practical strategies to improve de-implementation processes at all levels of the health care system. The framework and the strategies can thereafter be evaluated for their validity and impact in future studies.